In 1995, when I started my career in healthcare, I was fascinated by the telemedicine service at the medical center where I worked. Based in Honolulu, HI, Tripler Army Medical Center, as it was then called, had a medical catchment area that covered 70% of the world's surface. Much of that was the Pacific Ocean, so many of the more than 800,000 patients we had to cover, were spread across that ocean in small tribes on tiny islands that were officially protected by the United States.
That posed no small challenge.
People on those small islands, many miles away, many flight hours away, got sick just like the veterans, servicemen and women, and their dependents, who lived within a mile or two of Tripler.
So telemedicine in the mid-90's consisted of physicians, typically internists, who took turns in a rotation to fly out to certain regional island bases where they would set up what we called a "doc in a box." The doctor saw patients in a small, mobile, exam room that was connected by camera and microphone back to our medical center in Honolulu. At Tripler, any team or specialist could be called to the telemedicine lab to consult on a patient's condition thousands of miles away on one of these small islands.
Of course not every patient that needed treatment or an exam lived on that regional touchpoint specifically, so often they would travel by canoe from one island to another to reach the "doc in the box." Patient, family, and physician went through great lengths to get together. These people, not just the physicians but the islanders and their families too, opened up the telemedicine frontier and proved that it can work.
All types of routine measurements were taken to screen for disease. They took blood pressure to screen for hypertension. Glucose samples were taken to identify diabetics. X-rays were taken by the internist on the island, who transmitted them back to Tripler where they were read by a board-certified Radiologist. One of the exams I remember required a Dermatologist at Tripler to weigh in on a rash with which one of the island patients had presented. The Dermatologist diagnosed the patient's condition as "Margarita Dermatitis," also known as phytophotodermatitis. The rash and blistery skin can appear when juice from fruit like limes (commonly grown on islands like Tahiti and Niue since the 1930's) come in contact with strong sunlight on the skin. Stand in the South Pacific sun, bite into a lime, some juice squirts on your cheek and chin, and voila...you break out into this rash called Margarita Dermatitis.
Not all of the conditions diagnosed were so harmless. There were several islanders who were diagnosed with heart disease, and ended up on a small-engine plane trip back to Tripler to be operated on by a cardiothoracic surgical team. The diet on which many people living on those island nations were raised included lots of unhealthy canned meats. Cheap to process, produce, and then distribute throughout the remote regions of the South Pacific, this prevalent foodstuff unfortunately led to too many patients needing heart surgery before their twentieth birthday, I remember.
Today
Though the actual technological devices may have gotten smaller, telemedicine today still serves the same purpose. The process still includes a caregiver and patient remotely connected to a specialist who aids in diagnosis and a treatment plan.So this basic process of telemedicine, along with advances in technology that have put smart devices in almost everyone's hands, have given birth to what has become known as mobile health, a.k.a. mHealth, or connected health. This stage actually makes it possible for a patient with a smart phone, cell phone, personal data assistant, a PC or laptop with an internet connection, to stay in touch with their healthcare team without needing to take up time in an office visit so often. Patients receive frequent and timely wellness tips about nutrition and exercise, motivation and coaching, and alerts to tell that when it's time to take a dose of their prescriptions.
Patients are trained to record their exercise and diet intake into their device to send that data back to their doctor's office. They also use home devices that record their blood pressure and blood sugar, and then transmit those readings back to the doctor's office so that their healthcare team can monitor progress--or catch a need for an early intervention. Mobile Health may help Accountable Care Organizations eventually improve healthcare quality, while also reducing the cost of that care. So far, that has been the great challenge of our advancing healthcare system since the discovery of penicillin in the late 1930's.
